Modified Valsalva Maneuver for Supraventricular Tachycardia

Daniel M. Lindberg, MD reviewing Appelboam A et al. Lancet 2015 Aug 24.

A simple modification in the Valsalva maneuver dramatically increased its effectiveness.

The Valsalva maneuver is recommended first-line treatment for stable patients with supraventricular tachycardia, although it is successful in only a minority of patients. These authors tested whether a modified Valsalva maneuver can improve cardioversion rates.

In a randomized, controlled trial, 433 patients who presented to 10 U.K. emergency departments (EDs) with supraventricular tachycardia (not including atrial fibrillation or flutter) performed a standard Valsalva maneuver (15-second, 40-mm Hg strain while in a semirecumbent position) either alone or followed immediately by supine repositioning (by reclining the head of the bed) and passive leg raise to 45 degrees. Each maneuver was repeated once for patients who did not convert.

Among the 428 participants included in the intention-to-treat analysis, presence of sinus rhythm 1 minute after the maneuver was significantly more common in the modified-maneuver group than in the control group (43% vs. 17%). The number needed to treat was between three and four. Adenosine was administered to significantly fewer patients in the modified maneuver group than in the control group (50% vs. 69%). ED discharge rates and length of stay were similar in the two groups.

Citation(s):

Appelboam A et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): A randomised controlled trial. Lancet 2015 Aug 24; [e-pub].